Association of Diverticulosis and Spinal Cord Injury

Abstract

Introduction: Spinal cord injury (SCI) patients have been shown to have decreased quality of life and higher rates of GI complaints including chronic constipation. Etiologies for diverticulosis including chronic constipation have previously been proposed. With access to a large SCI population at Hines VA, this investigation looks for statistically significant differences in specific colonic lesions in a SCI population. Methods: We investigated colonoscopy and flexible sigmoidoscopy reports for 246 spinal cord injury veterans who had these procedures at Hines VA. To build a control list, we then randomly selected 1025 unique colonoscopy reports from non-SCI patients performed during the same period. Procedures performed through ostomies and those cancelled due to poor bowel prep were excluded due to inability to visualize the colon properly. These procedures were performed on veterans, by the same endoscopists, with the same equipment and reporting procedures, during the same time frame. All reports were reviewed for documentation of observed diverticulosis. Both SCI and non-SCI reports were also reviewed for colonoscopy prep grade as noted in the report and were reported as excellent, very good, good, fair, and poor. Results: Of the 246 SCI patients, 79 had diverticulosis present providing a rate of 32.1%. This is in contrast to the control group of 1025 non-SCI patients who had 551 cases of diverticulosis providing a rate of 53.7% (P value < 0.001). This trend also holds within given prep qualities. For 74 SCI patients with colonoscopies marked ‘good,’ 37.8% had diverticulosis compared to the 51.9% of 462 non-SCI patients (P value = 0.0328). For 145 SCI patients with preps marked ‘fair,’ 29% had diverticulosis compared to the 56% of 515 non-SCI patients (P value < 0.0001). Of note, average age of SCI patients at colonoscopy is 67 while the average age of non-SCI patients at colonoscopy is 61.6. Conclusion: There is a significant association between SCI patients and reduced rates of diverticulosis compared to our control population. This difference is further reinforced by the observation that this holds true despite the SCI population being older. While diverticulosis is likely multifactorial in etiology, a negative association between nerve injury and rates of diverticulosis is strongly suggesting by these findings. Further investigation into these processes may help clarify some of the elusive mechanisms of diverticulosis.